My two year old son was admitted into a children’s hospital with high blood sugar (186 first thing in morning) about a month ago. We were sent home and asked to continue monitoring with a FreeStyle Flash. During the time he was admitted, he has just recently been having symptoms thirst, increased urine, behavioral, and just recently had some weight loss. His appointment is not until the end of the month.

His blood sugars have been getting higher, ranging anywhere from 89 to 406 with our 14 day average at 160. They did full antibody testing, although I will not know the results until I go in. Mainly I am wondering if antibodies will still be positive even if this is only the pre-diabetes stage. I am also wondering how much a person’s blood glucose should fluctuate. His levels could be 120, then an hour or so later be 230, then 45 minutes later be 180. Is that normal? In your opinion, is the wait and see approach the one to take with my son? If this is diabetes, how long is the typical onset period from where we are at now?

Yes, typically antibodies against the pancreas are measurable well before the onset of clinical disease.

A normal serum glucose generally is thought to be between 60 and 110 mg/dL, although by definition, diabetes is not present unless the fasting level is more than 125 mg/dL OR if a random level is more than 200 with the presence of classic symptoms such as increased thirst, increased urination, weight loss, etc.

The blood glucose ranges you report for your son are probably not normal. Be certain that the testing site is clean and dry before getting the little lancet drop of blood. Make sure your meter is well calibrated. Given what you have shared, a “watchful-waiting” approach seems reasonable, although I would be quick to intervene pending a change in the clinical status or if the antibodies are positive.

Classically stated, 85-95% of the pancreatic ability to secrete insulin is gone before full-fledged symptoms of diabetes are thought to occur. And in general, it takes about 6+ months for the insulin secreting process to be corrupted enough to lead to this degree of destruction in typical antibody mediated Type 1 diabetes.

DS